New research presented at the European Respiratory Society International Congress shows that primary care physicians (PCPs) play an important role in the identification of COPD and other respiratory conditions but there is room for improvement. The Early Diagnosis of Obstructive Lung Disease (E-DIAL) study involved 6,390 primary care patients in Italy with a mean age of 56.3 years. After each patient completed a respiratory questionnaire and underwent a physical examination, the PCP decided whether to refer the patient to a chest specialist for further assessment, reports Medscape.
Of the 701 patients referred to one of 22 participating pulmonary units, specialists agreed with the alleged diagnosis in 494 cases. Among the diagnoses confirmed were COPD in 23.9% of cases, rhinitis in 9.5%, asthma in 20.4%, chronic bronchitis in 23.3% and asthma plus rhinitis in 2.9%. According to lead investigator Isabella Annesi-Maesano, MD, PhD, DSc, of the 494 patients with confirmed diagnoses, 18% had reported respiratory complaints to their PCP but described themselves as healthy.
The Medscape news report indicates that this study “lends weight to the evidence that case finding using a respiratory screening questionnaire is a reasonable approach in primary care and facilitates the identification of new cases of COPD,” says Rachel Jordan, PhD, from the University of Birmingham in the UK. However, in the recent TargetCOPD trial, Jordan and colleagues found that routine screening by PCPs is inferior to a targeted approach for identifying COPD.
Jordan says, “The key question in the identification of undiagnosed COPD is whether it is actually beneficial to the patient in the long term.”
Overall, the study found that COPD diagnoses were confirmed in more than 70% of the patients referred to a chest specialist by a PCP. Annesi-Maesano says, “Our results reveal that GPs, if informed and trained, can contribute to the screening of COPD at the primary care level.”